The setup: A nurse practitioner inquired about a 50-year-old female patient with complaints of progressive difficulties swallowing. It had been worsening for years; the patient assumed it was just “heartburn.” She had lost significant weight. 

Gastrointestinal staff was unable to pass a pediatric endoscope due to “tubular esophagus.” Interventional radiology was able to obtain distal esophageal biopsies, which were positive for marked inflammation and eosinophilia.

The outcome: Extensive food-allergy testing revealed marked atopic responses to a wide variety of foods that were common in this patient’s diet. A percutaneous endoscopic gastrostomy (PEG) tube was placed for tube-feeding of an elemental diet supplement and an oral slurry of low-dose steroid. 

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After three months of this treatment her esophagus had healed enough to allow passage of a pediatric scope. Treatment is to be continued to maximal resolution of symptoms. (191-3)

Sherril Sego, FNP-C, DNP, is a staff clinician at the VA Hospital in Kansas City, Mo., where she practices adult medicine and women’s health. She also teaches at the nursing schools of the University of Missouri and the University of Kansas.

The Clinical Advisor asked our Advisor Forum consultants what sorts of clinical questions they have fielded from their colleagues lately and what puzzling cases they have encountered themselves. We invite you to participate. If you have a clinical pearl or clinical question, submit it here.